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OneThousandOne represents the amount of time, verbally, that it takes to count to one second. In this one second of time, a great thing happened at The Nebraska Medical Center. In fact, several great things probably happened. A patient was cured, a researcher found the missing link, a nurse treated an injury, a doctor comforted a family or maybe a child just smiled.
MOMENTS IN MEDICINE at THE NEBRASKA MEDICAL CENTER
Fall | Winter 2010

Fighting for Every Breath

Certain that her racing heart and the tingling down her left arm were signs of a heart attack, Joann Mieska tried to be calm as her manager summoned paramedics to the Council Bluffs, Iowa, casino where Mieska works.

After an ambulance ride to a local hospital, doctors told Mieska that a chest X-ray and computer tomography (CT) scan indicated nothing abnormal regarding her heart. Perhaps she had suffered an anxiety attack, they said.

“It was Feb. 24, 2007,” Mieska recalls. “My life changed forever that day.”

But her relief lasted only a moment. They’d found something else. A spot on her right lung.

Lung cancer. Two words that can literally take a person’s breath away.

According to the American Cancer Society, in 2010 more than 1.5 million new cancer cases were expected in the United States, and more than 1,500 cancer-related deaths each day. Lung cancer is the most common cause of cancer death, accounting for 29 percent of cancer deaths in men (followed by prostate cancer at 11 percent), and 26 percent of cancer deaths in women (followed by breast cancer, 15 percent).

Cigarette smoking and exposure to secondhand smoke are the most significant risk factors for lung cancer.

Although the one-year survival for lung cancer has increased, largely due to improvements in surgical techniques and combined therapies, the American Cancer Society reports the five-year survival rate for all stages combined is only 16 percent.

The five-year survival rate is highest when the disease is still localized, but few lung cancers (roughly 15 percent) are diagnosed at this early stage.

Rudy Lackner, MD

That’s because lung cancer initially lacks symptoms that warrant medical attention, says Rudy Lackner, MD, thoracic surgeon at The Nebraska Medical Center, and professor of Surgery and chief of the Section of Thoracic Surgery at the University of Nebraska Medical Center (UNMC). “Persistent coughs, chest pain, shortness of breath or recurring infections don’t usually present themselves until the tumor is growing,” he says.

Studies are underway locally and nationally to find new, non-invasive ways of detecting lung cancer, such as testing sputum for cancer cells or checking the chemicals present in a person’s breath, Dr. Lackner says.

“There is enough data out there to endorse lung cancer screening,” he says. “If it’s found earlier, there is a much better chance of survival. But you have to screen a lot of people to find a small number of cancers. The question is, what’s the optimal group who should undergo screening?”

Until screening and early detection become more prevalent, most cases of lung cancer are diagnosed after other medical conditions arise. “That’s why probably 75 percent of the patients we see are already at a more advanced stage III or stage IV,” Dr. Lackner says.

Joann Mieska

Such was the case with Joann Mieska. Although a smoker since she was 18, the 57-year-old mother of two says that prior to the anxiety episode, “I had no symptoms at all.”

After examining the information and X-rays from the hospital, Mieska’s physician, Susan Schwerdtfeger, MD, referred her to Dr. Lackner.

“Joann came to me with a stage III disease,” Dr. Lackner says. “At that stage, there’s only about a five percent cure rate.”

Mieska didn’t care about rates and statistics.

“Giving up wasn’t an option,” she says. “It can be for some people. I can’t imagine how I’d feel if I heard nothing but bad news over and over. A person can lose the will to live. It happens. It just wasn’t an option for me.”

Treatment for lung cancer is determined by the type (small cell or non-small cell) and stage of cancer, Dr. Lackner says. Options include surgery, radiation therapy, chemotherapy and “targeted therapies” such as bevacizumab (Avastin) and erlotinib (Tarceva).

“Having a full slate of options available really sets us apart.”
Rudy Lackner, MD

Surgery is usually the treatment of choice. Because the disease has often spread by the time it is discovered, radiation and chemotherapy can be employed along with surgery. This is referred to as combination or multimodality treatment.

Neoadjuvant treatment refers to radiation or chemotherapy prior to surgery to help shrink the tumor and ease its removal.

Chemotherapy or radiation after surgery is called adjuvant treatment. The goal of adjuvant treatment is to kill any cancer cells that may remain and hopefully lower the risk that the cancer may return.

“We offer some of the more aggressive treatments available, both before and following surgery,” Dr. Lackner says. “Having a full slate of options available really sets us apart.”

Decisions on treatment rely upon the advice of the medical team. The Nebraska Medical Center is unique in the region in that it has a team of surgeons, oncologists, radiologists, nurses and others dedicated to the treatment of lung cancer.

“It’s the sole focus of what we do,” Dr. Lackner says.

He and Karen Trujillo, MD, are the only thoracic surgical oncologists in Nebraska with practices limited to cancers of the chest. “And we are working to add a third oncologist,” Dr. Lackner says.

He says patients benefit from the equipment and expertise available at The Nebraska Medical Center and UNMC.

“Data indicate the chance for long-term survival improves when the medical people involved are dedicated to this disease,” Dr. Lackner says. “We have the tools, technology and the skills necessary for successfully diagnosing and treating lung cancer.”

For Joann Mieska, reassurance came not in tools or technology but in Dr. Lackner’s calm, confident manner and the support of others on the medical team.

 “He is very down to earth, very cool,” Mieska says. “He’s straight up honest with you. I don’t know if everyone likes that, but I sure do.”

Within five days of her ambulance ride to the hospital, Mieska underwent surgery to remove the upper lobe of her right lung and several lymph nodes. She remained hospitalized for 11 days, then was sent home to rest for four weeks before the start of radiation treatments and chemotherapy.

That, she says, is when the road really got rough.

Standing 5 feet tall and weighing 112 pounds, few would imagine Joann Mieska as a prize fighter, but she took on lung cancer with all the determination of a champion.

And it nearly knocked her out.

“I had radiation five days a week for five weeks,” she recalls. “They say chemo is bad, but radiation is a sneaky little guy. You don’t feel anything, and then you do.”

The radiation treatments were localized and lasted no more than five minutes but the side effects were intense, she says.

“Your skin gets a weird, rough texture to it,” she says. “The radiation screwed up my esophagus, too. It got so constricted and contorted that I had a difficult time even drinking water.”

She lost muscle and weight, falling to 92 pounds. “You don’t realize how many food commercials are on television until you can’t eat,” she says. “I wanted to throw my shoe at the TV.”

With 16 weeks of chemotherapy came the loss of her hair. “I didn’t think it bothered me until one day I realized my eyelashes were gone,” she says.

She had bad days, she says, but benefitted from the support of her grown sons, Jeremiah and Zachary; as well as Dr. Lackner; her oncologist, Apar Ganti, MD; radiologist Ken Zhen, MD; and the nurses and other medical staff.

“They are truly there for you,” she says. “They’ll do anything to help. The nurses in the chemo area are very upbeat and full of life. It’s about as much as you can hope for in a situation like that. Every time I felt the least bit of hesitation, Dr. Ganti was there to say, ‘You want to beat this, don’t you?’”

She did, so she continued to fight the odds.

“Cancer is a tough teacher. You learn to prioritize what’s really important, like family, and not to worry and stew and get crabby over things that are out of your control.”
Joann Mieska

Today, Mieska is still on her job as a casino cashier supervisor. Her hair has grown back, and she’s rebounded to a whopping 102 pounds, thanks in part to three procedures to dilate her esophagus.

“When I was finally told I could eat anything, I came home and had chicken noodle soup,” she recalls. “You don’t know how excited I was about a bowl of soup.”

Mieska has an infectious laugh, a genuine smile and a positive attitude. “Cancer is a tough teacher,” she says. “You learn to prioritize what’s really important, like family,” she says, “and not to worry and stew and get crabby over things that are out of your control.”

Though technically cancer free for three years, she’s still wary.

“I do worry that it could come back, or come back someplace else,” she says. “I think most people who have been through this feel that way, and if not, shame on them. You shouldn’t take that for granted.”

That’s why whenever someone refers to her as a cancer survivor, Mieska is quick to add two words.

“So far,” she says. “I’m a survivor, so far.”

Next article in the Fall | Winter 2010 issue of One Thousand And One:
Facing Reform